Outcomes of Type 2 Diabetes Management Program in Pharmacy

1. Outcomes of Type 2 Diabetes Management Program in Pharmacy Toondee W., Pulbutr P. and Nitipaichit R.Faculty of Pharmacy and Health sciences, Mahasarakham university, Mahasarakham Thailand 44150

2. Abstract • Problem statement: Diabetes patients are a group of regular visitors to chronic outpatients department of hospitals for medication refill. Each visit took times because of the large amount of diabetic patients. So we try to create new effective and efficient model to diabetic patient management in a pharmacy. This may be another choice for the patients and may be a part of government insurance program in the future • Objectives: To compare outcomes between the patients in diabetes management program in pharmacy and control group. • Design: quasi-experimental study design. • Setting and population: Type 2 Diabetes outpatients who took oral hypoglycemic drugs and without serious complication during April 2002-June 2002 at provincial hospital. Patients who volunteered to participate in diabetes management program in pharmacy for 1 year. • Interventions: diabetes management program consists of refilled prescription, adjust dose along protocol (supervise by physicians), patient's assessments by interview and diabetic education. • Outcome measure: Outcomes included changed (from baseline) in HbA1C and quality of life. The satisfaction was assessed at the end of study. • Results: Forty-eight type 2 diabetes patients were recruited. They were males 18.75% and female 81.25%, age 51+/-5.28 years. There were 24 eligible patients in both treatment group who were volunteered in diabetic management program in University pharmacy and in the control group who received conventional service in the hospital. Both group were no significant difference between sex, age and duration of diabetes(p=0.28,p=0.90,p=0.22,respectively). HbA1C level declined by 0.02% in intervention subjects versus increased by 0.5% in control subjects. The treatment group had better quality of life and higher satisfaction than control group but no statistic difference(p=0.13, p=0.55,respectively). • Conclusion: This model offers an alternative medical service to diabetic patients for prescription refill and controlling blood sugar.

3. Introduction Diabetic patients are group of the most finding chronic diseases in Thailand. Diabetes patients regularly visit outpatient departments in a hospital for medication refills. These medical settings require a number of health care providers and there are also time consuming. We tried to set a new and effective model for diabetic patients management in a pharmacy. This innovation may offer another option for diabetic patients. Moreover, the effective settings in pharmacy may be a part of health care insurance in the near future.

4. Objective • To develop an alternative model of medication refill for diabetic patients in a pharmacy. • To evaluate the developed pharmacy setting in type II diabetic patients who had been evaluated by physicians.

5. Method • Design: This study is quasi experimental study design. • Study Population: Type II diabetic patients who visited diabetic clinic of outpatient department in a provincial hospital from April to June 2002 were asked to participate this study. The patients should take oral anti-diabetic agents and did not have any serious complications which were evaluated by physicians. There were two groups of patients in this study. In control group, patients preferred to visit at traditional hospital setting. In treatment or intervention groups, patients volunteered to visit a newly developed diabetic management program in a pharmacy. Clinical data were collected continuously from both groups throughout one year.

6. Method (Cont.) • Interventions: Patients in conventional hospital setting received original diabetic management by health care provider. Patients in a pharmacy setting received prescription refill and dosage adjustment according to the protocol which was supervised by physicians. They were also interviewed to assess clinical problems and obtained knowledge about diabetes treatment and self care from a pharmacist.

7. Method (Cont.) • Outcome Measures: Hemoglobin A1C (HbA1C) and quality of life of patients in both control and treatment groups were determined at the beginning and the end of the experiment. Patient satisfaction was also determined at the end of the study in both groups.

8. Results control group(n=24) treatment group(n=24) P • Sex : male 4(16.7%)5(20.8%) >0.05 : female 20(83.3%) 19(79.2%) >0.05 • age (years) : 52.12+/- 49.88 • duration : 6.00 - 8.74

9. Results • Mean HbA1C(%) P • baseline 12-months • Control group 8.48 8.93 +0.45 >0.05 • Treatment group 8.39 8.37 -0.02

10. Results • Patients participating in a pharmacy setting also had higher quality of life and satisfaction than those in control group. Nevertheless, these differences were not significant (p=0.13 and p=0.55, respectively).

11. Conclusion • Since clinical data (HbA1C), quality of life and satisfaction of patients in a new alternative diabetic management were equal or better than those of patient in conventional setting. This model may provides an alternative medical service for diabetic patients to refill their prescription and to control their clinical parameter such as blood sugar.